ON THE DRUGS PHENOMENON FROM THE PERSPECTIVE OF MULTICENTER STUDIES IN LATIN AMERICA AND THE CARIBBEAN

The drugs phenomenon is one of the greatest challenges countries are confronted with in the 21 century. It is well known that drugs use and abuse influence and negatively affect the health of people, families and communities, as well as national and international development, social stability and security. The globalization process can direct or indirectly facilitate drugs trade, as well as the development of money laundry mechanisms, contributing to increased drugs consumption in different population groups. That makes the drugs phenomenon a global problem. Many countries have emphasized the association between drugs and terrorism and have direct or indirectly reinforced drugs control laws. In the context of the black market, drugs are considered a lucrative source of money; at the same time, this market can be associated with arms trade and violence against civilians and governments all over the world. National policies highlight the importance of reducing drugs consumption, taking into account, for example, the risk of acquiring HIV/AIDS among injection drugs user, or greater accident risks, or the chronic damage that can be associated with drugs use. Psychoactive substance consumption affects users’ body and mind. These effects range from alterations in physiological functions to modified time and space perceptions, as well as alterations in states of awareness about the consumers’ environment. It can be affirmed that drugs abuse and addiction result from a combination of three factors: a product (alcohol and other drugs), a person with his history and individual vulnerabilities and a social, cultural, political and economic context. In particular, it is fundamental to integrate the importance of social determinants of health and development into the analysis of and answers given to substance consumption, including the strong inequities that exist in the region. Likewise, it should be considered that many people present comorbidities due to addiction and mental health problems at the same time. In view of the above, a comprehensive approach is needed, which does not remain limited to an emphasis on the substance alone. Hence, the drugs phenomenon is an old problem in a new context. Countries face difficulties to control production and trade and reduce demand. That makes drugs use and abuse into a paramount theme on the national and international agenda, due to the damage they cause in countries’ social, economic and political aspects. The current global context demands specialized professionals, who are capable of analyzing problems and presenting solutions and/or strategies with national and international perspectives, based on scientific data. Most OAS members states do not have specialized professional staff at their disposal, with scientific knowledge and sufficient research experience on drugs and related problems to work in national drugs commissions, research centers or academic professional training programs. In general, countries have neither established long-term programs or planning to research on the drugs phenomenon, nor have they managed to incorporate research results into national drugs control policies. To solve this problem, however, some developing countries have linked up with developed ones to outline strategies for scientific advances in research on the drugs phenomenon. In that context, CICAD (Inter-American Drug Abuse Control Commission) has developed strategies to strengthen institutional capacities and human resources related to drugs demand reduction, security and money laundering in its member-states.

The globalization process can direct or indirectly facilitate drugs trade, as well as the development of money laundry mechanisms, contributing to increased drugs consumption in different population groups.That makes the drugs phenomenon a global problem.Many countries have emphasized the association between drugs and terrorism and have direct or indirectly reinforced drugs control laws.In the context of the black market, drugs are considered a lucrative source of money; at the same time, this market can be associated with arms trade and violence against civilians and governments all over the world (3) .
National policies highlight the importance of reducing drugs consumption, taking into account, for example, the risk of acquiring HIV/AIDS among injection drugs user, or greater accident risks, or the chronic damage that can be associated with drugs use (3) .Psychoactive substance consumption affects users' body and mind.These effects range from alterations in physiological functions to modified time and space perceptions, as well as alterations in states of awareness about the consumers' environment.It can be affirmed that drugs abuse and addiction result from a combination of three factors: a product (alcohol and other drugs), a person with his history and individual vulnerabilities and a social, cultural, political and economic context.In particular, it is fundamental to integrate the importance of social determinants of health and development into the analysis of and answers given to substance consumption, including the strong inequities that exist in the region.Likewise, it should be considered that many people present comorbidities due to addiction and mental health problems at the same time.In view of the above, a comprehensive approach is needed, which does not remain limited to an emphasis on the substance alone.
Hence, the drugs phenomenon is an old problem in a new context.Countries face difficulties to control production and trade and reduce demand.That makes drugs use and abuse into a paramount theme on the national and international agenda, due to the damage they cause in countries' social, economic and political aspects.
The current global context demands specialized professionals, who are capable of analyzing problems and presenting solutions and/or strategies with national and international perspectives, based on scientific data.Most OAS members states do not have specialized professional staff at their disposal, with scientific knowledge and sufficient research experience on drugs and related problems to work in national drugs commissions, research centers or academic professional training programs.
In general, countries have neither established long-term programs or planning to research on the drugs phenomenon, nor have they managed to incorporate research results into national drugs control policies.
To solve this problem, however, some developing countries have linked up with developed ones to outline strategies for scientific advances in research on the drugs phenomenon.In that context, CICAD (Inter-American Drug Abuse Control Commission) has developed strategies to strengthen institutional capacities and human resources related to drugs demand reduction, security and money laundering in its member-states.Since 1998, CICAD has organized the Association Program with Latin American Universities, aimed at introducing the drugs theme into undergraduate and graduate course curricula, with a view to developing research and community service activities in nursing, public health, education and medicine.Nowadays, CICAD collaborates with more than 174 colleges in Latin America and the Caribbean.Regional and international training programs on international health, the drugs phenomenon, research and leadership constitute new strategies for human resource training in the region, so as to address the drugs phenomenon in a global to support, with scientific evidence, public policy development, decision making, program and project management and assessment and (iv) to permit exchanges between regional and Canadian researchers in the field of the drugs phenomenon (4)   .
The Program has been preparing 51 professionals, 31 of whom have graduated, while 20 are finishing their multicenter research and preparing scientific papers about the research results for publication in specialized journals.As for the distribution by nationality, the Program has received participants from 16 countries (Argentina, 1; Brazil, 13; Chile, 5; Colombia, 7; Costa Rica, 1; Ecuador, 2; El Salvador, 1; Guatemala, 3; Honduras, 2; Jamaica, 4; Mexico, 2; Nicaragua, 3; Peru, 3; Panama, 1; Paraguay, 1; Uruguay, 1).The following academic areas are represented in the Program: Medicine, Nursing, Public Health, Social Work/Service, Education and Law (4) .This kind of program offers a series of advantages for the development of multicenter research: (i) the central research theme is important to different countries and the region; (ii) it permits collaboration among researchers during design, elaboration, publication and dissemination; (iii) favors cooperation among countries and participant organizations; (iv) facilitates the mobilization/exchange of resources and responsibilities; (v) promotes the establishment of research networks; (vi) permits the development of graduate theses and dissertations (Master's and Ph.D.) for in-depth analysis of specific aspects in the results (5)(6) .This Journal presents articles on the general results found in the countries involved in each of the multicenter studies, followed by articles with specific results from sites where information was collected for different participant countries.The print version of this supplement contains 22 articles, issued in Spanish, while English and Portuguese versions are available on-line at http://www.scielo.br.rlae.Thus, once again, the Latin American Journal of Nursing (RLAE) contributes together with CICAD/OAS and CAMH to put in practice a specialized human resource training policy for research and activities on drugs demand reduction in Latin America and the Caribbean.

This supplement of the
*CAMH (www.camh.net) is a WHO/PAHO Collaborating Centre affiliated with the University of Toronto.It develops the following main areas: clinical services, research, education, public policies and health promotion.Its International Health Office collaborates with multiple countries in the search for and implementation of effective and sustainable answers, in view of actual needs in Mental Health and Addictions.An important part of CAMH's international work is focused on Latin America and the Caribbean, with strong emphasis on skills development in interprofessional health teams, researchers, leaders and decision-makers, among others.
context.As from 2003, CICAD created the "International Research Program for Professionals in Health and Related Areas to Study the Drugs Phenomenon in Latin America (English acronym IRCBP)", first associated with the University of Alberta, Canada (2003-2004), and soon afterwards with the Center for Addictions and Mental Health-CAMH, in Toronto, Canada * (from 2006 until today).The Program objectives are: (i) to prepare professional staff in health and related areas with scientific and technical competencies (attitudes, knowledge and skills) in research so as to permit scientific advances in the drugs phenomenon -especially related to drugs demand reduction; (ii) to permit the development of multicenter research to study the different aspects of the drugs phenomenon, especially in the field of drugs demand reduction in Latin America and the Caribbean; (iii) Latin American Journal of Nursing (RLAE) summarizes the articles of participants who graduated from the Program in 2006-2007 and 2007-2008.The theme of the multicenter research participants developed in 2006-2007 was: "Illicit drugs use in 7 Latin American countries: a critical perspective on the family and close contacts", and, in 2007-2008: "Standards perceived by college students about drugs use by their peers: a multicenter study in 5 Latin American countries".